1. Chapter 11 Preventing Falls
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2. Falls Falls are the most common accidents in nursing centers.
The risk of falling increases with age.
A history of falls increases the risk of falling again.
Falling is often a sign of other health problems.
Persons older than 65 years are at risk.
According to the Centers for Disease Control and Prevention (CDC):
About 1800 nursing center residents die each year from falls.
Nursing center falls can cause serious injury, including fractures. Fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand are the most common. Hip fractures and head trauma increase the risk of death.
Falls result in disability, decline in function, and reduced quality of life.
Fear of falling can cause further loss of function, depression, feelings of helplessness, and social isolation. This may increase the person’s risk of falling again.
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3. Causes and Risk Factors for Falls
Most falls occur in resident rooms and bathrooms.
Falls are most likely to occur:
Between 1600 (4:00 pm) and 2000 (8:00 pm)
During shift changes
Poor lighting, cluttered floors, incorrect bed height, and out-of-place furniture are causes; so are wet and slippery floors, bathtubs, and showers.
Wheelchairs can cause falls if they do not fit the person or are in poor repair.
Needing to use the bathroom, usually to urinate, is a major cause of falls.
During shift changes, staff are busy going off and coming on duty. Confusion can occur about who gives care and answers signal lights. The accident risk factors described in Chapter 10 can lead to falls.
The problems listed in Box 11-1 on p. 151 also increase a person’s risk of falling.
Know your role during shift changes. Nursing staff going off-duty and those of the oncoming shift must work together to prevent falls.
Review Teamwork and Time Management: Causes and Risk Factors for Falls on p. 151.
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4. Fall Prevention Programs
Nursing centers have fall prevention programs.
Common sense and simple safety measures can prevent many falls.
The goal is to prevent falls without decreasing the person’s quality of life.
The entire health team must protect the person from harm. If you see something unsafe, tell the nurse at once. Do not assume the nurse knows or that someone is tending to the matter.
The care plan also lists measures for the person’s specific risk factors.
Answer all signal lights promptly. This includes the signal lights of residents assigned to co-workers.
Nursing centers have fall prevention programs. The measures listed in Box 11-2 on p. 152 are part of such programs and the person’s care plan.
Common sense and simple safety measures can prevent many falls. The health team works with the person and family to reduce the risk of falls. The goal is to prevent falls without decreasing the person’s quality of life.
Review Focus on Communication: Fall Prevention Programs on p. 151.
Review Promoting Safety and Comfort: Fall Prevention Programs on p. 151.
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5. Bed Rail Regulation Bed rails
A bed rail (side rail) is a device that serves as a guard or barrier along the side of the bed. Bed rails are raised and lowered. They lock in place with levers, latches, or buttons. Bed rails are half, three quarters, or the full length of the bed.
If a person needs bed rails, keep them up at all times except when giving bedside nursing care.
Bed rails present hazards. Entrapment is a risk.
Bed rails are considered restraints by OBRA and the Centers for Medicare & Medicaid Services (CMS) if:
The person cannot get out of bed.
The person cannot lower them without help.
Accrediting agency standards and state laws affect bed rail use.
The nurse and care plan tell you when to raise bed rails.
When half-length rails are used, each side may have two rails. One is for the upper part of the bed, the other for the lower part (see Fig. 11-4, p. 153).
They are needed by persons who are unconscious or sedated with drugs. Some confused or disoriented people need them.
The person can fall when trying to climb over them. Or the person cannot get out of bed or use the bathroom.
Entrapment means that the person can get caught, trapped, entangled, or strangled (see Chapter 15).
If you are allowed to chart, record when you check the person and your observations (see Fig. 11-5, p. 154).
See Promoting Safety and Comfort: Bed Rails on p. 154.
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6. Bed Rail Regulation (Cont’d)
Bed rails cannot be used unless needed to treat a person’s medical symptoms. The need for bed rails is carefully noted in the person’s medical record and the care plan.
Bed rails are allowed when the person’s condition requires them.
If a person uses bed rails:
Check the person often.
Report to the nurse that you checked the person.
If you are allowed to chart, record when you checked the person and your observations.
Accrediting agency standards as well as federal and state laws affect bed rail use.
Bed rails must be in the person’s best interests.
Some people feel safer with bed rails up. Others use them to change positions in bed. The person or legal representative must give consent for raised bed rails.
Review Promoting Safety and Comfort: Bed Rails, p. 154.
Adjust the overbed table so it is within the person’s reach. Ask if the person wants other items nearby. Place them on the overbed table too. Always make sure needed items, including the signal light, are within the person’s reach.
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7. Hand Rails, Grab Bars, Wheel Locks-Safety Devices
Hand rails are in hallways and stairways.
Grab bars are in bathrooms and in shower/tub rooms.
Bed legs have wheels. Each wheel has a lock to prevent the bed from moving. They are locked at all times except when moving the bed.
Make sure bed wheels are locked:
When giving bedside care
When you transfer a person to and from the bed
Wheelchair and stretcher wheels are locked during transfers.
Hand rails give support to persons who are weak or unsteady when walking (see Fig. 11-6, p. 155).
Grab bars (safety bars) provide support for sitting down or getting up from a toilet. They also are used for getting in and out of the shower or tub (see Fig. 11-7, p. 155).
You or the person can be injured if the bed, wheelchair, or stretcher moves while transferring a person. Each wheel has a lock to prevent the bed from moving (see Fig. 11-8, p. 155).
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8. Transfer/Gait Belts
A transfer belt (gait belt) is a device used to support a person who is unsteady or disabled.
It helps prevent falls and other injuries.
The belt goes around the person’s waist.
Grasp under the belt to support the person during the transfer or when assisting the person to walk.
When used to transfer a person (see Chapter 14), it is called a transfer belt. When used to help a person walk, it is called a gait belt (see Fig. 11-9, p. 155).
Transfer/gait belts are routinely used in nursing centers. If the person needs help, a belt is required. To use one safely, always follow the manufacturer’s instructions.
Review Promoting Safety and Comfort: Transfer/Gait Belts on p. 156.
Review the Applying a Transfer/Gait Belt procedure on p. 156.
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9. The Falling Person Falling may be caused by:
Weakness, lightheadedness, or dizziness
Fainting
Slipping or sliding on spills, waxed floors, throw rugs, or improper shoes
Do not try to prevent the fall.
If a person starts to fall, ease him or her to the floor.
Do not let the person move or get up before the nurse checks for injuries.
A person may start to fall when standing or walking.
If you try to prevent the fall, you could injure yourself and the person.
Easing the person to the floor lets you control the direction of the fall. You can also protect the person’s head.
If you find a person on the floor, do not move him or her. Stay with the person, and call for the nurse.
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10. After a Fall An incident report is completed after all falls.
A confused person may not understand why you do not want him or her to move or get up after a fall.
You may need to let the person move for his or her safety or your own.
Never use force to hold a person down.
Stay calm and call for help.
Help the nurse return the person to bed. Ask other staff to help if needed.
Provide for comfort, make sure signal light is in reach, follow the care plan in regard to bed rails, complete a safety check of the room, assist the nurse as needed with the incident report.
Review Residents with Dementia: The Falling Person on p. 156.
Review the Helping the Falling Person procedure on p. 157 in the textbook.
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11. Quality of Life
Residents have the right to feel safe. Fear of falling does not make a person feel safe.
A fall can seriously affect a person’s quality of life.
Some persons may feel restricted by the use of safety devices.
Before moving a person, explain what you are going to do and what he or she needs to do. Also give step-by-step instructions as you progress. Do not move the person without telling him or her first. These measures help increase the person’s comfort.
Do not let the person talk you out of performing a safety measure or using a safety device. Safety is always a priority.
You must help prevent falls.
You must not interfere with the person’s rights.
Take the time to:
Find and use assistive devices.
Put proper footwear on the person.
Raise or lower the bed and side rails as appropriate.
Lock wheels on beds, stretchers, and wheelchairs.
Ask others to help if needed.
Good communication promotes comfort. It supports the person’s right to safety and security.
Listen to the person’s concerns. Kindly explain the reason for the safety device. If the person still refuses, tell the nurse.
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